Measurement of intracranial pressure (ICP) and arterial blood pressure is used to derive cerebral perfusion pressure (CPP) and to guide targeted therapy of severe traumatic brain injury (TBI) necessitating ICU admission. In this narrative review we discuss the evidence for ICP monitoring, CPP calculation, and ICP/CPP-guided therapy after severe TBI. Despite its widespread use, there is currently no class I evidence that ICP/ CPP-guided therapy improves outcomes. Similarly, no class I evidence can currently advise the ideal CPP. ‘Optimal’ CPP is likely patient-, time-, and pathology-specific and related to cerebral autoregulation status. The fact that optimal CPP and autoregulation status varies between individual patients and over time makes it an attractive bedside tool to serve as a (simplified) model to investigate the use of autoregulation status to fine tune or give feedback on clinical treatments in individual sedated patients (optimal CPP concept).
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